Elsevier

Resuscitation

Volume 65, Issue 3, June 2005, Pages 265-277
Resuscitation

International Resuscitation Network Registry: design, rationale and preliminary results

https://doi.org/10.1016/j.resuscitation.2004.12.019Get rights and content

Abstract

There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies.

A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or movement in individuals for whom the EMS system is activated for whom an arrest record is completed. All data were collated via a secure and confidential web-based method by using automated forms processing software with appropriate variable range checks, logic checks and skip rules. Median number of missing responses for each variable was 0 (interquartile range 0, 0). Twenty-seven percent of the patients had a first recorded rhythm of ventricular fibrillation or ventricular tachycardia, 60% had a witnessed arrest, and 34% received bystander CPR. Mean time from call to arrival on scene was 7.1 ± 5.1 min. Six percent of the patients survived to hospital discharge. The resuscitation process was highly variable across centers, and survival and neurological outcome were also significantly and independently different across centers.

This study shows that it is possible to collect data prospectively describing the structure, process and outcome associated with cardiac arrest in multiple international sites via the internet. Therefore, it is feasible to conduct adequately powered randomized trials of resuscitation therapies in international settings.

Introduction

While there has been a steady decline in morbidity and mortality from most cardiovascular diseases over the last 30 years [1], [2], [3], [4], there has been little improvement in survival from sudden cardiac arrest. Also, there is a lack of high-quality information about the effectiveness of resuscitation interventions after out-of-hospital cardiac arrest [5] and uniformly collected data that enables comparisons between different emergency medical systems and countries [6]. An internet-based international registry could make such comparisons possible, and enable the conduct of large randomized controlled trials of resuscitation therapies.

We present here the design and initial observations of such an international registry, the International Resuscitation Network Registry (IRN Registry). Although these preliminary results are not representative of the true situation in the participating sites, they illustrate that it is feasible to prospectively collect uniform data describing outcomes after cardiac arrest in multiple international sites. We confirm that structure, process and outcome after cardiac arrest differ among international sites. Finally, we demonstrate the feasibility of a simple methodology that would facilitate the conduct of large simple randomized trials of promising resuscitation interventions.

Section snippets

Design

Multisite prospective cohort study (Appendix A).

Population

Infants, children and adults with out-of-hospital sudden cardiac arrest.

Setting

Goteberg, Sweden; Oslo, Norway; Perth, Western Australia; Richmond, Virginia, USA; Toronto, Ontario, Canada and Wilmington, Delaware, USA.

Inclusion criteria

Individuals who experienced out-of-hospital cardiac arrest requiring chest compressions or external defibrillation, on whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or

Results

Enrolled subjects had cardiac arrest between March 1996 and November 2003. The five participating sites served populations of median 517,401 (interquartile range 470,787, 1,600,125) by responding to median 33,161 (interquartile range 27,643, 60,090) calls annually (Table 1). The skill level EMS providers varied from center to center, consisting of basic life support and defibrillation and/or advanced cardiac life support.

Five hundred and seventy one patients with out-of-hospital cardiac arrest

Discussion

To the best of our knowledge, this is the first, prospective web-based international registry of consecutive cases of out-of-hospital cardiac arrest. Participating sites were able to provide de-identified data in compliance with confidentiality regulations that was more than 95% complete for the majority of Utstein criteria. Therefore, it is feasible to collect standardized structure, process and outcome data relating to cardiac arrest in international sites. This enables description of

Conclusions

To the best of our knowledge, this is the first web-based study to collect data prospectively describing structure, process and outcome associated with cardiac arrest in multiple international sites. Such data collection is feasible. Our results demonstrate that it is feasible to collect prospectively uniform data describing outcomes after cardiac arrest in multiple international sites. We confirm that structure, process and outcome after cardiac arrest are highly variable among international

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  • Cited by (0)

    A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at 10.1016/j.resuscitation.2004.12.019.

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